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Medical Management After a Missed Pregnancy Loss

Expert Insights from Dr Catriona Melville, Specialist in Sexual & Reproductive Health, and a qualified Obstetrician and Gynaecologist, background research for this episode was prepared by Kristina Fox and Naomi Clark

Medical Management After a Missed Pregnancy Loss

What to expect if you use medication to help your body “let go”

Medical management i.e. medication is usually offered when a pregnancy loss has been confirmed, but the pregnancy hasn’t completely passed on its own. It’s one of the options used to manage a missed pregnancy loss. Some women choose it because they want to avoid surgery or waiting longer.

Medical management is usually taken at home, not in hospital. You’ll be managing this in your own space, which makes preparation important.

Some women have told us they weren’t prepared for how strong the pain or bleeding might be. Others said they felt caught off guard by side effects like nausea or dizziness. This section brings together what they said they wish they’d known, so you can plan ahead, ask questions, and make the space around you feel as safe and manageable as possible.

How it works

Medical care usually involves two steps, taken a couple of days apart.

  • The first medication, mifepristone, is taken by mouth. It begins to affect the hormones that support the pregnancy and helps the body prepare for what’s next.
  • One to two days later, the second medication, misoprostol, is used to help the uterus contract. It’s placed between your cheek and gum and allowed to dissolve slowly. Cramping and bleeding usually start a few hours after this. Common side effects of misoprostol are feeling shivery, nausea, vomiting and diarrhoea.

What to expect

Everyone experiences this differently. Some women feel okay with rest and pain relief. Others describe it as more intense than they expected. What’s important is knowing what’s normal and that support is available.

You may experience:

  • Cramping that may be stronger or more intense than a period, especially in the first few hours
  • Heavy bleeding, often with clots
  • Nausea, vomiting, diarrhoea, sweating, or hot flushes
  • Fatigue and emotional shifts as hormone levels change

If you’re worried about managing pain or side effects, you can ask your doctor about pain relief and anti-nausea medication ahead of time.

Things that can help

  • Use pads rather than period underwear. This helps you see how much you’re bleeding, especially if clots are involved. Period underwear can hold a lot but won’t give you a clear sense of blood loss.
  • Don’t use tampons or have sex until the bleeding has fully stopped. This helps reduce the risk of infection.
  • Choose a space where you can rest, use the toilet easily, and aren’t likely to be disturbed.
  • Try to keep some food and water nearby. Staying hydrated and having something small to eat can help if you’re feeling shaky or nauseous.
  • If you have someone nearby, it can be helpful. If not, you can still prepare the space around you and take things at your own pace.
  • Plan for time off work or other responsibilities, if possible, especially on the day of the second medication.
  • Avoid driving after taking the second dose. Some women feel faint or overwhelmed during the time when bleeding is at its heaviest.

When to seek medical help

Contact your doctor or seek emergency care if you:

  • Soak more than 2 pads an hour for more than 2 hours
  • Feel faint, dizzy, or unwell
  • Develop a fever, chills, or foul-smelling discharge
  • Have pain that isn’t settling
  • Are still bleeding heavily after two weeks

What happens next

You’ll usually have a follow-up appointment within one to two weeks. This is to check whether everything has passed and to talk about how you’re feeling. Some people need a second dose of medication. Your doctor may recommend surgical care to remove the remains of your pregnancy if everything has not passed.

Your next period may come a little earlier or later. Fertility can return quickly, sometimes within two weeks, so if you’re not ready for another pregnancy, ask about contraception.

Before you start, it’s okay to ask

You don’t have to know everything going in. If there’s something you’re unsure about, ask your GP or care provider. Here are some questions other women have found helpful:

  • What can I take for pain or nausea?
  • How long should I expect the bleeding to last?
  • What signs mean something might not be right?
  • What happens next if it doesn’t work fully?
  • Can I get a certificate for work or support for leave?
  • What kind of emotional support is available if I need it?

This guide was written as a reference you can come back to. It’s not meant to replace medical advice, but to support it, especially if it’s hard to take everything in during appointments.

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Miscarriage Australia, n.d. Your emotions. [online] Available at: https://www.miscarriageaustralia.com.au [Accessed 12 Aug. 2025].

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NHS, n.d. Miscarriage – Afterwards. [online] Available at: https://www.nhs.uk [Accessed 12 Aug. 2025].

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Pregnancy Birth and Baby, n.d. What happens after miscarriage. [online] Available at: https://www.pregnancybirthbaby.org.au [Accessed 12 Aug. 2025].

Royal Women’s Hospital, n.d. Miscarriage. [online] Available at: https://www.thewomens.org.au [Accessed 12 Aug. 2025].

Therapeutic Goods Administration, n.d. Amendments to restrictions for prescribing of MS-2 Step (mifepristone and misoprostol). [online] Available at: https://www.tga.gov.au [Accessed 12 Aug. 2025].

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Need Immediate Help?

If you or someone you know is struggling during the postnatal period, it’s crucial to remember that immediate help is available. Here are steps and resources you can turn to:

In Urgent Situations:

  • Hospital Emergency: Visit your nearest hospital emergency department.
  • Ambulance: Dial triple zero (000) for immediate medical assistance.

Support Services:

  • Beyond Blue: Offers guidance for depression and anxiety. Call 1300 224 636.
  • Lifeline: Provides critical support and suicide prevention. Contact 131 114.
  • Women’s Domestic Crisis Service: For domestic violence support, call 1800 015 188.
  • WIRE (Women’s Information and Referral Exchange): For information and support, dial 1300 134 130.
  • PANDA (Perinatal Anxiety & Depression Australia): For perinatal anxiety and depression support, call 1300 726 306.
  • Parent Line: For parent support, reach out to 132 289.
  • Sands: Offers support for miscarriage, stillbirth, and newborn death issues. Contact 1300 072 637.

Remember, you are not alone, and reaching out for help is a step toward healing. Your well-being is important, and support is just a phone call away.